{"id":4062,"date":"2025-11-11T06:10:25","date_gmt":"2025-11-11T05:10:25","guid":{"rendered":"https:\/\/acos-france.org\/?p=4062"},"modified":"2026-09-08T11:07:13","modified_gmt":"2026-09-08T09:07:13","slug":"pr-pablo-dighiero-dgm-and-etao-a-structural-clinical-pathway","status":"publish","type":"post","link":"https:\/\/acos-france.org\/en\/pr-pablo-dighiero-dgm-and-etao-a-structural-clinical-pathway\/","title":{"rendered":"Prof. Pablo Dighiero: MGD and eTAO, a structured clinical pathway"},"content":{"rendered":"<p>[fusion_builder_container type=&#8221;flex&#8221; hundred_percent=&#8221;no&#8221; hundred_percent_height=&#8221;no&#8221; min_height_medium=&#8221;&#8221; min_height_small=&#8221;&#8221; min_height=&#8221;&#8221; hundred_percent_height_scroll=&#8221;no&#8221; align_content=&#8221;stretch&#8221; flex_align_items=&#8221;flex-start&#8221; flex_justify_content=&#8221;flex-start&#8221; flex_column_spacing=&#8221;&#8221; hundred_percent_height_center_content=&#8221;yes&#8221; equal_height_columns=&#8221;no&#8221; 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The plan literally serves as a clinical guideline.<br \/>\n<em><strong>The spirit of the article:<\/strong> fewer trials\/errors, more traceable decisions. 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animation_offset=&#8221;&#8221; last=&#8221;true&#8221; border_position=&#8221;all&#8221; first=&#8221;true&#8221;][fusion_text columns=&#8221;&#8221; column_min_width=&#8221;&#8221; column_spacing=&#8221;&#8221; rule_style=&#8221;&#8221; rule_size=&#8221;&#8221; rule_color=&#8221;&#8221; hue=&#8221;&#8221; saturation=&#8221;&#8221; lightness=&#8221;&#8221; alpha=&#8221;&#8221; content_alignment_medium=&#8221;&#8221; content_alignment_small=&#8221;&#8221; content_alignment=&#8221;&#8221; hide_on_mobile=&#8221;small-visibility,medium-visibility,large-visibility&#8221; sticky_display=&#8221;normal,sticky&#8221; class=&#8221;&#8221; id=&#8221;&#8221; margin_top=&#8221;&#8221; margin_right=&#8221;&#8221; margin_bottom=&#8221;&#8221; margin_left=&#8221;&#8221; fusion_font_family_text_font=&#8221;&#8221; fusion_font_variant_text_font=&#8221;&#8221; font_size=&#8221;&#8221; line_height=&#8221;&#8221; letter_spacing=&#8221;&#8221; text_transform=&#8221;&#8221; text_color=&#8221;&#8221; animation_type=&#8221;&#8221; animation_direction=&#8221;left&#8221; animation_color=&#8221;&#8221; animation_speed=&#8221;0.3&#8243; animation_delay=&#8221;0&#8243; animation_offset=&#8221;&#8221;]<\/p>\n<h2>Structuring the examination with eTAO\u2026 without friction<\/h2>\n<p>eTAO remains our compass: Epithelium, Telangiectasias, Atrophy, Obstruction. In practice:<\/p>\n<ul>\n<li><strong>To be systematically captured:<\/strong> OSDI\/SANDE, <strong>NIBUT\/BUT<\/strong>, <strong>MGS<\/strong>, <strong>lid margin photos<\/strong>, <strong>meibography<\/strong> (\u00b1 <strong>MMP-9<\/strong> if indicated).<\/li>\n<li><strong>To be recorded:<\/strong> eTAO per eye (OD\/OS), to visualize the evolution and decide unilateral\/bilateral as needed.<\/li>\n<li><strong>To be standardized:<\/strong> pre-filled <strong>eTAO report<\/strong> template (time-saving, traceability).<\/li>\n<li><strong>If you use the online tool <a href=\"https:\/\/dryeyescore.com\/en\/\" target=\"_blank\" rel=\"noopener\">DryEyeScore<\/a>,<\/strong> align your criteria labels to facilitate before\/after comparison.<\/li>\n<\/ul>\n<h2>Choosing the procedure according to the phenotype\u2026 and the patient&#8217;s objective<\/h2>\n<p>We don&#8217;t \u201ccollect\u201d procedures: we target them.<\/p>\n<ul>\n<li><strong>Dominant Telangiectasias \u2192<\/strong> <strong>IPL<\/strong> in <strong>series (3\u20134)<\/strong>, <strong>\u00b1 expression<\/strong> if associated plug. Success indicators at 3\u20136 months: <strong>TBUT\/NIBUT \u2191<\/strong>, <strong>improved lid margin photos<\/strong>, <strong>OSDI\/SANDE \u2193<\/strong>.<\/li>\n<li><strong>Obstruction + thickened meibum \u2192<\/strong> <strong>Thermography + guided expression<\/strong> (VTP\/equivalents). Reasonable expectation: <strong>lasting benefit<\/strong> with control at 3\u20136 months, maintenance if relapse.<\/li>\n<li><strong>Inflammatory\/sensitive skin (thermal intolerance, reactive skin) \u2192<\/strong> <strong>QMR (electric current devices)<\/strong> in <strong>4\u20138 sessions<\/strong>, alone or <strong>in combo<\/strong>. We seek <strong>comfort<\/strong> and <strong>inflammatory modulation<\/strong> without heat constraint.<\/li>\n<\/ul>\n<h2>Combining without burdening: the \u00ab IPL Plus \u00bb spirit<\/h2>\n<p>The combination is not a gimmick: it&#8217;s <strong>anti-inflammation (IPL)<\/strong> + <strong>mechanical clearance<\/strong> (expression\/thermo), or <strong>QMR<\/strong> depending on the patient&#8217;s profile. We refine the treatment schedule rather than doing everything at once.<\/p>\n<h2>Monitoring without overtreating<\/h2>\n<ul>\n<li><strong>Useful windows:<\/strong> <strong>T+3\u20136 months<\/strong>, then <strong>6\u201312 months<\/strong> depending on phenotype, season and visual demands (screens, contact lenses).<\/li>\n<li><strong>Retreatment triggers (to be configured locally):<\/strong>\n<ul>\n<li>Return of <strong>symptoms<\/strong> + degradation of <strong>at least one objective criterion<\/strong> (<strong>NIBUT\/BUT<\/strong>, <strong>MGS<\/strong>, <strong>lid margin photo<\/strong>).<\/li>\n<li>eTAO stable but <strong>new functional constraint<\/strong> (e.g., increased screen activity).<\/li>\n<\/ul>\n<\/li>\n<li><strong>Patient education:<\/strong> short sheet (heat\/hygiene, blinking, environment), systematically sent.<\/li>\n<li>Note: the approach aligned with the article was highlighted in our 2024 meetings (eTAO session and choice of procedures). If you are training a new person in orthoptics, base it on this framework. <a href=\"https:\/\/acos-france.org\/programme-acos-2025\/\">ACOS France<\/a><\/li>\n<\/ul>\n<h2>Key points to keep handy<\/h2>\n<ul>\n<li><strong>eTAO above all<\/strong>: the score guides the <strong>phenotype<\/strong> and the <strong>timing<\/strong> of the procedure.<\/li>\n<li><strong>IPL<\/strong> for <strong>dominant telangiectasias<\/strong>; <strong>Thermo+expression<\/strong> for <strong>obstruction\/thick meibum<\/strong>; <strong>QMR<\/strong> as a <strong>non-thermal option<\/strong> (alone or in combo).<\/li>\n<li><strong>\u201cIPL Plus\u201d<\/strong>: combine <strong>at the right time<\/strong>, not systematically.<\/li>\n<li><strong>Scheduled follow-up<\/strong>: control at <strong>3\u20136 months<\/strong>, then <strong>6\u201312 months<\/strong>; define <strong>re-treatment criteria<\/strong> in advance.<\/li>\n<li><strong>Traceability<\/strong>: standardized eTAO report, comparable photos (same angle\/light), simple dashboard.<\/li>\n<\/ul>\n<p>[\/fusion_text][\/fusion_builder_column][\/fusion_builder_row][\/fusion_builder_container][fusion_builder_container type=&#8221;flex&#8221; 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link_target=&#8221;_self&#8221; hide_on_mobile=&#8221;small-visibility,medium-visibility,large-visibility&#8221; sticky_display=&#8221;normal,sticky&#8221; class=&#8221;&#8221; id=&#8221;&#8221; content_align_medium=&#8221;&#8221; content_align_small=&#8221;&#8221; content_align=&#8221;center&#8221; size=&#8221;3&#8243; animated_font_size=&#8221;&#8221; fusion_font_family_title_font=&#8221;&#8221; fusion_font_variant_title_font=&#8221;&#8221; font_size=&#8221;1.6em&#8221; line_height=&#8221;&#8221; letter_spacing=&#8221;&#8221; text_transform=&#8221;&#8221; text_color=&#8221;&#8221; hue=&#8221;&#8221; saturation=&#8221;&#8221; lightness=&#8221;&#8221; alpha=&#8221;&#8221; animated_text_color=&#8221;&#8221; text_shadow=&#8221;no&#8221; text_shadow_vertical=&#8221;&#8221; text_shadow_horizontal=&#8221;&#8221; text_shadow_blur=&#8221;0&#8243; text_shadow_color=&#8221;&#8221; margin_top_medium=&#8221;&#8221; margin_right_medium=&#8221;&#8221; margin_bottom_medium=&#8221;&#8221; margin_left_medium=&#8221;&#8221; margin_top_small=&#8221;&#8221; margin_right_small=&#8221;&#8221; margin_bottom_small=&#8221;&#8221; margin_left_small=&#8221;&#8221; margin_top=&#8221;&#8221; margin_right=&#8221;&#8221; margin_bottom=&#8221;&#8221; margin_left=&#8221;&#8221; margin_top_mobile=&#8221;&#8221; margin_bottom_mobile=&#8221;&#8221; gradient_font=&#8221;no&#8221; gradient_start_color=&#8221;&#8221; gradient_end_color=&#8221;&#8221; gradient_start_position=&#8221;0&#8243; gradient_end_position=&#8221;100&#8243; gradient_type=&#8221;linear&#8221; radial_direction=&#8221;center center&#8221; linear_angle=&#8221;180&#8243; highlight_color=&#8221;&#8221; style_type=&#8221;default&#8221; sep_color=&#8221;&#8221; link_color=&#8221;&#8221; link_hover_color=&#8221;&#8221; animation_type=&#8221;&#8221; animation_direction=&#8221;left&#8221; animation_color=&#8221;&#8221; animation_speed=&#8221;0.3&#8243; animation_delay=&#8221;0&#8243; animation_offset=&#8221;&#8221;]<\/p>\n<p><b>Templates to integrate into your forms<\/b><\/p>\n<p>[\/fusion_title][fusion_builder_row_inner][fusion_builder_column_inner type=&#8221;1_2&#8243; 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animation_offset=&#8221;&#8221;]<\/p>\n<h3>\u00a0\u201cinformed consent\u201d<\/h3>\n<ul>\n<li><strong>Purpose:<\/strong> MGD management <strong>guided by eTAO<\/strong> (options: <strong>IPL<\/strong>, <strong>Thermo+expression<\/strong>, <strong>QMR<\/strong>).<\/li>\n<li><strong>Expected benefits:<\/strong> improvement of symptoms\/signs, reduction of recurrences.<\/li>\n<li><strong>Specific prescription:<\/strong> routine eyelid hygiene and artificial tears as needed<\/li>\n<li><strong>Contraindications\/precautions:<\/strong> according to device (photosensitization, skin conditions, etc.).<\/li>\n<li><strong>Maintenance:<\/strong> controls <strong>3\u20136<\/strong> then <strong>6\u201312 months<\/strong>; retreatment if criteria met<\/li>\n<\/ul>\n<p>[\/fusion_text][\/fusion_builder_column_inner][fusion_builder_column_inner type=&#8221;1_2&#8243; layout=&#8221;1_2&#8243; align_self=&#8221;auto&#8221; content_layout=&#8221;column&#8221; align_content=&#8221;flex-start&#8221; valign_content=&#8221;flex-start&#8221; content_wrap=&#8221;wrap&#8221; spacing=&#8221;&#8221; center_content=&#8221;no&#8221; column_tag=&#8221;div&#8221; link=&#8221;&#8221; target=&#8221;_self&#8221; link_description=&#8221;&#8221; min_height=&#8221;&#8221; hide_on_mobile=&#8221;small-visibility,medium-visibility,large-visibility&#8221; sticky_display=&#8221;normal,sticky&#8221; class=&#8221;&#8221; id=&#8221;&#8221; type_medium=&#8221;&#8221; type_small=&#8221;&#8221; order_medium=&#8221;0&#8243; order_small=&#8221;0&#8243; dimension_spacing_medium=&#8221;&#8221; dimension_spacing_small=&#8221;&#8221; dimension_spacing=&#8221;&#8221; dimension_margin_medium=&#8221;&#8221; dimension_margin_small=&#8221;&#8221; dimension_margin=&#8221;&#8221; padding_medium=&#8221;&#8221; padding_small=&#8221;&#8221; padding_top=&#8221;&#8221; padding_right=&#8221;&#8221; padding_bottom=&#8221;&#8221; padding_left=&#8221;&#8221; hover_type=&#8221;none&#8221; border_sizes=&#8221;&#8221; border_color=&#8221;&#8221; border_style=&#8221;solid&#8221; 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sticky_offset=&#8221;&#8221; absolute=&#8221;off&#8221; absolute_props=&#8221;&#8221; filter_type=&#8221;regular&#8221; filter_hover_element=&#8221;self&#8221; filter_hue=&#8221;0&#8243; filter_saturation=&#8221;100&#8243; filter_brightness=&#8221;100&#8243; filter_contrast=&#8221;100&#8243; filter_invert=&#8221;0&#8243; filter_sepia=&#8221;0&#8243; filter_opacity=&#8221;100&#8243; filter_blur=&#8221;0&#8243; filter_hue_hover=&#8221;0&#8243; filter_saturation_hover=&#8221;100&#8243; filter_brightness_hover=&#8221;100&#8243; filter_contrast_hover=&#8221;100&#8243; filter_invert_hover=&#8221;0&#8243; filter_sepia_hover=&#8221;0&#8243; filter_opacity_hover=&#8221;100&#8243; filter_blur_hover=&#8221;0&#8243; transform_type=&#8221;regular&#8221; transform_hover_element=&#8221;self&#8221; transform_scale_x=&#8221;1&#8243; transform_scale_y=&#8221;1&#8243; transform_translate_x=&#8221;0&#8243; transform_translate_y=&#8221;0&#8243; transform_rotate=&#8221;0&#8243; transform_skew_x=&#8221;0&#8243; 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content_alignment_medium=&#8221;&#8221; content_alignment_small=&#8221;&#8221; content_alignment=&#8221;&#8221; hide_on_mobile=&#8221;small-visibility,medium-visibility,large-visibility&#8221; sticky_display=&#8221;normal,sticky&#8221; class=&#8221;Bloc_droit&#8221; id=&#8221;&#8221; margin_top=&#8221;&#8221; margin_right=&#8221;&#8221; margin_bottom=&#8221;&#8221; margin_left=&#8221;&#8221; fusion_font_family_text_font=&#8221;&#8221; fusion_font_variant_text_font=&#8221;&#8221; font_size=&#8221;&#8221; line_height=&#8221;&#8221; letter_spacing=&#8221;&#8221; text_transform=&#8221;&#8221; text_color=&#8221;&#8221; animation_type=&#8221;&#8221; animation_direction=&#8221;left&#8221; animation_color=&#8221;&#8221; animation_speed=&#8221;0.3&#8243; animation_delay=&#8221;0&#8243; animation_offset=&#8221;&#8221;]<\/p>\n<h3>Report template (to be duplicated OD\/OS)<\/h3>\n<ul>\n<li><strong>eTAO :<\/strong> e__, T__, A__, O__ | <strong>NIBUT\/BUT<\/strong> : __ | <strong>MGS<\/strong> : __ | <strong>OSS<\/strong> : __<\/li>\n<li><strong>Lid margin photos<\/strong> : yes\/no | <strong>Meibography<\/strong> : yes\/no (atrophy: __) | <strong>MMP-9<\/strong> : yes\/no<\/li>\n<li><strong>Phenotype:<\/strong> T\u2191 \/ O\u2191 \/ mixed \/ sensitive<\/li>\n<li><strong>Decision:<\/strong> IPL (n sessions __) \/ Thermo + MGX \/ QMR (n sessions ) \/ Combo ( + __)<\/li>\n<li><strong>Home care:<\/strong> heat\/hygiene\/screen (details)<\/li>\n<li><strong>Follow-up:<\/strong> T+__ | <strong>re-treatment criteria<\/strong> no<\/li>\n<\/ul>\n<p>[\/fusion_text][\/fusion_builder_column_inner][\/fusion_builder_row_inner][\/fusion_builder_column][\/fusion_builder_row][\/fusion_builder_container]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>[fusion_builder_container type=&#8221;flex&#8221; 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